Heleen Vermandere

During this session, qualitative data from Brazil was presented, pointing out the main barriers of implementing Prep according to various stakeholders. Moreover, examples were given on how to use implementation science to increase the impact of health programs. Finally, the role and us of cost-effectiveness studies were discussed.

Qualitative interviews among stakeholders in Brazil revealed that while willingness-to-use prep was high many barriers inhibited uptake. Stigma and discrimination were main concerns, but also logistical barriers were mentioned: health services opening hours were limited as well as the number of staff offering prep. Moreover, out-of-pocket costs for transport were a problem. Offering prep outside HIV facilities would not only help reducing stigma but also eliminate these practical hindrances. Furthermore the importance of easy-to-understand information was highlighted. Finally, stakeholders worried that other health priorities would jeopardize the sustainability of prep programs. To implement successful programs, the following steps were presented: identify stakeholders and engage them throughout the study, hold data interpretation workshops, disseminate findings and implement a plan to apply them. To design successful programs, a number of biomedical, behavioral and structural interventions are available. However, it is unclear in which context which strategies would yield cost-effective results.

While implementation science focuses a lot on the impact of interventions, cost-effectiveness studies remain rather rare. There is limited documentation of real-world implementation not only in terms of impact but also in terms of costing. More efforts should go to reporting programs expenditures, human resources, etc. Only with this information, program designers and policy makers can define an optimal combination of interventions to reduce HIV.